Lose the weight, gain a suit of skin

Body image still an issue if rapid weight loss leaves excess skin

When she finally decided less was better, she started making nutritional changes and exercising, eventually shedding 191 pounds.

Today, Olds’ health is better, she feels better and has tons of energy. Life should be great, right? Not exactly.

One thing that didn’t bounce back as quickly as her confidence was her skin.

Olds still has serious body image issues because of excess skin that sags on her arms, thighs and abdomen.

“It gets a little frustrating and sometimes it’s embarrassing,” said Olds, a DeKalb County, Ga., calendar clerk, who dropped from a size 30 or 32 to a 10 or 12.

For instance, Olds has to forgo short-sleeve summer tops in her size, shopping instead in the men’s department, where the sleeves are longer. She wears a larger size in pants to accommodate her abdomen. And, perhaps most disturbing of all, when Olds runs down Stone Mountain with her young son, she sometimes hears the skin on her arms “flapping.”

A patient will say “I want to wear a suit of skin that fits my body,” said Dr. Sheldon Lincenberg of Georgia Plastic Surgery. He said he usually doesn’t perform the procedure until a patient has stabilized his or her weight.

Obesity is a major problem in Georgia and the rest of the United States. About 200,000 adults in the U.S. have metabolic/bariatric surgery annually, according to the American Society for Metabolic & Bariatric Surgery.

For those who are considered morbidly obese, “if you lose 100 or 150 pounds, you can get rid of diabetes, high blood pressure, live longer and have a better life,” said Dr. Richard Greco, the CEO and senior partner with the Georgia Institute for Plastic Surgery. “The cruel joke is usually when you lose that much weight you have this sagging skin.”

Considering skin removal

Greco said about 80 percent of his patients who are interested in body contouring lost their weight after surgery. The rest lost it naturally.

How large the person was, age, elasticity, how much the skin has stretched and how quickly a person loses weight all influence how well the skin bounces back. But the biggest factor is genetics. Good genes can mean that even when people lose massive amounts of weight, say, at least 75 pounds, they still look good in the skin they’re in.

Perhaps the biggest obstacle is cost. Skin removal and related procedures can run into thousands of dollars. Based on one estimate, having skin removed from arms, breast, thighs, face and abdomen can range from $25,000 to $50,000.

In 2011, the number of procedures for body contouring after massive weight loss fell 0.8 percent to 50,442 cases, according to the American Society of Plastic Surgeons. Many surgeons attribute the slight drop to the fallout from the economic recession, when people put off nonessential procedures.

Most insurers will not pay for skin removal surgery, which is generally considered cosmetic, unless a medical reason is determined.

He said the economy forced a downturn in the number of actual procedures that occurred but didn’t put a damper on interest.

“People just don’t know if they can afford it,” he said.

Olds, who is much happier with her new size, wants to have plastic surgery to remove the skin, but she ran into some financial obstacles when she lost her job and later her husband lost his.

Feeling and looking better

TiJuana Ponder, 39, was always insecure about her arms, which she felt were too flabby. She never wore anything that showed her arms. Even in scorching temperatures, Ponder, a secretary, wore jackets.

When she lost 151 pounds — or as she puts it, “a whole person” — it got worse.

“I still saw the 305-pound person at first because of the skin,” she said. “You feel better, but you don’t look better. It takes the joy out of your hard work.”

The Covington, Ga., resident decided it was time to do something about the excess skin. She contacted Dr. Lisa Bootstaylor about surgery.

Bootstaylor said patients going through weight-loss surgery usually have a team to support them, but often what’s left out of the conversation is “what you’re really going to look like afterward.” She calls it the “snap-back quality” of skin.

Ponder doesn’t regret having surgery.

“This was my lifetime dream since high school,” Ponder said. “I was willing not to pay the mortgage or anything to get my arms done. It meant that much to me.” Her son noticed the difference in attitude immediately.

“My family loved the old me,” Ponder said, “but they really love the new me.”